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Right to Health Through Education: Mental Health and Human Rights*

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Right to Health Through Education: Mental Health and Human Rights* Right to Health Through Education: Mental Health and Human Rights* Riikka Elina Rantala, Natalie Drew, Soumitra Pathare, and Michelle Funk he World Health Organization (who) is a specialized United Nations agency responsible for providing leadership on global health matters. At the time of its creation in 1948, health was de- Tfined as being “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” However, in reality the main focus of global health work has predominantly been on physical health with much less focus given on mental and social health. Yet there is com- pelling evidence that mental health problems are one of the leading causes of sickness, disability, and even premature mortality in certain age groups.1 Indeed hundreds of millions of people worldwide are affected by mental, be- havioral, neurological and substance use disorders. For example, estimates made by who in 2002 showed that one hundred fifty-four million people globally suffer from depression and twenty-five million people from schizo- phrenia; 91 million people are affected by alcohol use disorders and fifteen million by drug use disorders.2 Another who report reveals that fifty million people suffer from epilepsy and twenty-four million from Alzheimer disease and other dementias.3 About 877,000 people die by commiting suicide every year.4 In addition it is well known that the human rights of the poorest and most marginalized people in society are most often violated or neglected, and people with mental disabilities are certainly no exception. Indeed, all 188 Right to Health Through Education: Mental Health and Human Rights 189 over the world people with mental disabilities experience severe and sys- tematic human rights violation. They are denied employment, education, housing and access to health care as well as civil liberties such as the right to vote. Even within the health care context people with mental disabili- ties experience wide-ranging abuses, with many people being locked away indefinitely in psychiatric institutions where they are exposed to inhuman or degrading treatment, including physical, sexual and mental abuse and neglect.5 Human rights education can play a significant role in reversing this situ- ation. Human rights and health have strong linkages, and lack of informa- tion and knowledge on the former will generally have a negative affect on the latter. Unfortunately, the potential value of human rights education to public health has not yet been fully realized. This article aims to clarify the important synergy between health and human rights, give a brief introduction to the work of who in this field and introduce one successful public health and education initiative in the South- East Asia region in which both mental health and human rights have been successfully brought together in the area of human rights education: The International Diploma in Mental Health Law and Human Rights, offered at the Indian Law Society (ils) Law College, Pune, India in collaboration with the World Health Organization. The Diploma is a first of its kind in Asia and a good example of higher-level human rights education in Asia. The recent entering into force of the United Nations Convention on the Rights of Persons with Disabilities (crpd)6 is a significant step forward in the promo- tion and protection of the rights of people with mental disabilities and will have an important impact on how relevant policies and laws are formulated in the future. The establishment of the Diploma, which aims to educate key national mental health actors on the crpd and other international human rights standards, is therefore particularly timely. Synergies between Health and Human Rights The first reference to “right to health” at an international level was provided by the Constitution of the who. The who Constitution recognized in 1948 “the enjoyment of the highest attainable standard of health” as “one of the fundamental rights of every human being without distinction of race, reli- gion, political belief, economic or social condition.”7 One of the most fun- 190 HUMAN RIGHTS EDUCATION IN ASIA-PACIFIC damental sources on the right to health is Article 12 of the International Covenant on Economic, Social and Cultural Rights (icescr) in which the right to health is defined as “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.” Article 25 of the crpd expands this, stating that “persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimi- nation on the basis of disability.” Several other international human rights treaties also recognize the right to health.8 International human rights law requires governments to ensure that legislation and policies, which will lead to accessible and affordable health care for all, are put in place in the shortest possible time. The right to health is not restricted to access to health care, but also extends to other underly- ing determinants of health, such as access to clean water and food, adequate sanitation and housing, healthy working conditions and access to health- related education and information. Health and human rights interact in several different ways. Firstly, hu- man rights violations such as torture, gender-based violence or harmful tra- ditional practices can result in poor mental and physical health. Secondly, the realization of human rights can reduce vulnerability to ill health. The right to information guarantees that people are aware of their health rights and can access scientifically valid health data on different health topics. The right to education also indirectly affects health as edu- cated people are generally better informed to make health-related decisions and are more likely to be able to afford healthier lifestyles.9 Human rights education is very important in this context. To stand up for their right to health and the right of others, people need to know and understand what their rights are. For example, health policy guaranteeing free antiretroviral drugs to hiv-positive persons is of little use if people are not aware of this right. Likewise, a mental health law that aims to promote free and informed consent to treatment is unlikely to curb coercive treatment practices if nei- ther mental health professionals nor service users are aware of this right. Thirdly, health and other policies can promote or violate human rights.10 For instance, national reproductive health policies or programs that exclude certain groups of people are discriminatory. Similarly health insur- ance schemes that specifically exclude payment for mental health care or offer lower levels of coverage for shorter periods of time violates the right to health as it is discriminatory and creates economic barriers to access- Right to Health Through Education: Mental Health and Human Rights 191 ing mental health services. Conversely, health or mental health policies that encourage autonomy, as well as social, health and other support services for people with mental disabilities are likely to promote a number of funda- mental rights enshrined in the crpd and other human rights instruments, such as the right to health, to liberty and security of person, to protection of physical and mental integrity, to exercise legal capacity, and to live indepen- dently and be included in the community. It is thus of utmost importance that those in the position of planning and implementing laws and policies have a profound understanding of human rights. Work of WHO in Health and Human Rights Although human rights are still somewhat neglected in development coop- eration efforts, they have slowly started to emerge in the global development arena since the 1990s and are increasingly being integrated into programs of work of the different UN organizations. Withinwho , human rights were first integrated into hiv/aids work, where linkages to human rights were particularly apparent. In 2003 who, along with other UN organizations, signed a document entitled “UN Common Understanding on a Human Rights-based Approach to Development Cooperation”,11 which states that human rights must constitute the objective and guiding principle of all de- velopment cooperation, and that the capacities of duty-bearers (govern- ments, local authorities) to meet their obligations and of rights-holders (in- dividuals) to claim their rights must be strengthened. Today the human-rights-based approach is employed in a number of projects and programs within who headquarters, regional offices and at the country level.12 In short, who aims through its human rights work to: • Strengthen the capacity of who and its Member States to integrate a human-rights-based approach to health • Advance the right to health in international law and international development processes • Advocate for health-related human rights. At the regional and country levels who supports governments in the implementation of the human-rights-based approach to national health policies and programs. Who can, for instance, provide human rights train- ing to ministries of health and to other stakeholders such as national human rights institutions. Health and human rights training is also offered to pub- 192 HUMAN RIGHTS EDUCATION IN ASIA-PACIFIC lic health and human rights practitioners, representatives of government ministries, national institutions, civil society and UN staff members through an e-learning course organized by who and InWEnt Capacity Building International Germany. Human-rights-related advocacy materials have also been produced and research conducted on specific health and human rights topics. In the South-East Asia Region, who human rights advocacy has focused on environmental health, hiv/aids and maternal and neonatal health. Who also has plans to support health and human rights education in secondary schools in the region, using dvd Health - My Right and published cartoons Right to Health and HIV/AIDS, Stand up for Human Rights as teaching materials in the classroom.
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